Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Sungmin Lim, Eun Ho Choo, Ik Jun Choi, Sang Hyun Ihm, Hee Yeol Kim, Youngkeun Ahn, Kiyuk Chang, Myung Ho Jeong, Ki Bae Seung, Sungmin Lim, Eun Ho Choo, Ik Jun Choi, Sang Hyun Ihm, Hee Yeol Kim, Youngkeun Ahn, Kiyuk Chang, Myung Ho Jeong, Ki Bae Seung

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI).

Methods: The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure.

Results: Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75-1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64-0.90; P = 0.002).

Conclusion: The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI.

Trial registration: ClinicalTrials.gov Identifier: NCT02385682.

Keywords: Acute Myocardial Infarction; Angiotensin Receptor Blocker; Angiotensin-Converting Enzyme Inhibitor; Percutaneous Coronary Intervention.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

© 2019 The Korean Academy of Medical Sciences.

Figures

Fig. 1. Study flow chart and treatment…
Fig. 1. Study flow chart and treatment groups.
ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker.
Fig. 2. Kaplan-Meier curves for the composite…
Fig. 2. Kaplan-Meier curves for the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure according to treatment groups.
ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker.
Fig. 3. Comparative unadjusted hazard ratios of…
Fig. 3. Comparative unadjusted hazard ratios of the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure for subgroups in the crude population according to treatment groups compared to an alternative use of angiotensin receptor blocker.
ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker, NSTEMI = non-ST-segment elevation myocardial infarction, STEMI = ST-segment elevation myocardial infarction.

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